Healthy Choices

Measles outbreak a ‘call to action’ for unvaccinated

Darrie Hutchison, a registered nurse at the Wichita Clinic in Wichita, Kan., draws a dose of mumps-measles-rubella – or MMR – vaccine in April 2006.
Darrie Hutchison, a registered nurse at the Wichita Clinic in Wichita, Kan., draws a dose of mumps-measles-rubella – or MMR – vaccine in April 2006. Associated Press file

A sweeping measles outbreak that has infected more than 70 people in California is causing physicians and public health officials to raise the alarm about the large number of people who either have not been vaccinated against the disease at all or have not received adequate boosters. Although one Sacramento County specimen came back negative for measles from state labs this week, another is being tested, with results expectedThursday.

Measles shots have been widely rejected in certain cultural and economic enclaves throughout Northern California over the past decade, according to research from the California Department of Public Health. Those communities will be the hardest hit if the highly infectious disease spreads northward, officials say.

Of the 79 confirmed measles cases in the state, 52 have been linked to initial exposure to the virus at Disneyland Park and Disneyland California Adventure Park in Anaheim during December. Among the infected are five Disneyland employees.

The Sacramento County Department of Health and Human Services confirmed this week that it was testing two suspected cases of measles. The first was a patient who arrived at a Sutter Medical Group pediatric clinic in Elk Grove on Jan. 14, said Gary Zavoral, spokesman for Sutter Health. Tests run by the facility and returned Jan. 21 prompted physicians to report the case to the county, which sent it to the state for further testing. Results came back negative Wednesday.

Dr. Olivia Kasirye, public health officer for Sacramento County, confirmed Wednesday that there is another potential Sacramento County measles case under investigation at the state lab.

Placer County Public Health Officer Dr. Robert Oldham said at least two specimens sent from patients in his county already came back negative, but that it is likely the region will have a confirmed case of measles in the coming weeks. Public health offices are preparing for the outbreak by urging health care providers and schools to make sure everyone is vaccinated, he added.

Measles, a highly contagious respiratory disease resulting in severe rash, fever and runny nose, was officially deemed eliminated from the United States in 2000. Since then the number of U.S. cases, most contracted in the the Philippines, Japan and other locations where measles is widespread, has gradually increased as people travel more and vaccinate less. Provisional data from the federal Centers for Disease Control and Prevention show 2014 as the peak of the disease’s comeback, with 644 cases nationwide.

Receiving the measles, mumps and rubella vaccine is the No. 1 way to prevent contracting measles, Oldham said. The disease has an infection rate of 90 percent for unvaccinated people exposed to the virus. It can be spread through a cough or sneeze, and can linger in the air for two hours after an infected person leaves a room.

“We’re looking this outbreak dead in the eye right now,” Oldham said. “This is the time to get just one MMR vaccination. Even if you’re not sure you’re 100 percent on board with all vaccination, please consider just getting one and getting some protection.”

The vaccine for the virus was developed in 1963 and was initially administered in one dose. In 1989, the CDC adjusted standards to recommend two doses – one between 12 and 15 months of age and one between ages 4 and 6. Anyone who was given two doses of the live virus vaccine during or after childhood is considered immune to the disease.

In light of the current outbreak, the CDC recommends that those who are unsure of their vaccination status call their physicians, and seek out a booster shot if necessary. Anyone born during or after 1957 who does not have documented evidence of receiving a live virus vaccine should get at least one dose as protection from the outbreak. Those immunized for measles, mumps and rubella between 1963 and 1967 should be particularly careful, as the vaccine administered during that time may have been a “killed” form of the virus, which was not effective, the CDC reports.

People born before 1957 are considered immune to measles because they lived through several years of measles epidemics and likely had the disease already. Most people who have already contracted measles will not contract it again.

The CDC also recommends that parents of young children check vaccination rates at their child’s school, which vary widely across California. Parents have historically been permitted to submit “personal belief exemption” forms to exclude their children from otherwise school-required vaccines. A recent state law, passed in 2012 in an effort to reduce the rate of unvaccinated children, now requires parents to have the form signed by a physician.

In January 2014, after testifying in favor of the new law, Dr. Dean Blumberg, chief of pediatric infectious disease at UC Davis Children’s Hospital opened a clinic for parents concerned about vaccinations, where he provides information and signatures, if needed.

While Blumberg does sign the form for those hard-set in their beliefs, he does his best to provide information about the vaccine to those who may be on the fence.

“We make sure parents know that if they’re choosing not to vaccinate their children, that can be dangerous,” he said. “This measles outbreak serves as a call to action about what can happen. ... A lot of people think they don’t need to get their kids vaccinated unless they travel. But they can be exposed right here.”

How quickly the disease spreads in a community largely depends on how many people are not vaccinated, said Dr. John Belko, chief of infectious disease for Kaiser Permanente Medical Center, south Sacramento. Geographic pockets where high rates of children are not immunized can pose a significant risk.

About 5 percent of Sacramento-area students started the 2014-15 school year without vaccines – more than double the statewide average, according to the state health department. The highest numbers of personal-belief exemption forms were filed in Slavic-speaking schools in Antelope and North Highlands, as well as affluent schools in Fair Oaks, Lincoln and Loomis.

The low vaccination rates at many area schools are concerning, but it isn’t for lack of access, Oldham said. Most of the schools he’s talking about are in high-income areas – a trend seen statewide in places such as Marin and Orange counties.

Oldham has been stressing to parents that it isn’t too late to bring kids in for shots.

In the event of an outbreak, he said, it is within the public health officer’s authority to exclude unvaccinated children from school.

“It’s not something we want to do,” he said. “But it is in our plan if it is needed to stop the spread.”

At Community Charters, a group of six schools, many of which serve families from the former Soviet Union, Assistant Superintendent Michael Gillespie said a fact sheet is being sent out to staff and parents to convey the importance of the MMR vaccine. Their most recent data indicates that 14 percent of students are not vaccinated, though the number of personal-belief forms filed has been dropping from year to year, he said.

“The more people are aware and the better educated they are, the more they can make better choices for their children,” Gillespie said. “We’re bringing in doctors, we’re holding family nights, so they can keep in mind all of the factors.”

David Johnson, a parent at Brookfield School a private K-8 school where 13 percent of children filed personal-belief exemption forms in 2013-14, said he believes getting children vaccinated is “absolutely necessary.” Though his daughter is immunized, he worries about her classmates who may not be. The school’s kindergarten vaccination numbers improved greatly in 2014-15.

“I feel like she’s protected,” he said. Brookfield’s kindergarten vaccination numbers improved greatly in 2014-15, “but the issue is that as soon as you get a lot of parents not vaccinating their kids, you have a vehicle for transmission.”

Call The Bee’s Sammy Caiola, (916) 321-1636. The Bee’s Ellen Garrison contributed to this story.

Who should get vaccinated for MMR?

Children:

▪ Ages 12 through 15 months who have not received their first dose of MMR vaccine. A second dose for full protection can be given 28 days later, but is usually given at four to six years of age.

▪ Age 6 months who will be traveling to a high-risk measles area

▪ School-aged children who have not received one or either recommended MMR vaccinations

Adults:

▪ Born after 1957 who were not vaccinated for MMR

▪ Born after 1957 and vaccinated between 1963 and 1967, when a “killed” form of the virus may have been used

▪ Working in a hospital or other medical facility

▪ Traveling internationally or taking a cruise

▪ Attending post-secondary educational institutions

Who does not require vaccination?

▪ Anyone whose blood tests show immunity to measles, mumps and rubella

▪ Anyone born before 1957

▪ Anyone who has had two doses of MMR or one dose of MMR plus a measles vaccine

Guidelines provided by the Centers for Disease Control and Prevention

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